PCC Infectious Disease and BBP This annual training includes this presentation plus the OSHA...
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Transcript of PCC Infectious Disease and BBP This annual training includes this presentation plus the OSHA...
PCC Infectious Disease and BBPThis annual training includes this presentation
plus the OSHA Bloodborne Pathogens Video. https://www.youtube.com/watch?v=gLeTNOVfh8o
This training is intended to review company policy and the Exposure Control Plan. This is in addition to American Red Cross training for those whose positions require that annual training.
Occupational Exposure to Bloodborne Pathogens
29 CFR 1910.1030
Bloodborne Pathogens Standard applies to all employees with occupational exposure to blood and other potentially infectious materials
Scope and Application 1910.1030(a)
HIV
Employees Potentially At Risk
Physicians and surgeons
Nurses
Phlebotomists
Medical examiners
Dentists and dental workers
Some laundry and housekeeping employees
Clinical/diagnostic laboratory workers
Medical technologists
Nursing home personnel
Dialysis personnel
BloodBloodborne pathogensOPIMContaminatedOccupational exposureExposure incidentRegulated wasteSESIPNeedleless system
Standard Specific Definitions 1910.1030(b)
Blood
Human blood
Human blood components
Products made from human blood
1910.1030(b)
Bloodborne Pathogens
Pathogenic organisms that are present in
human blood, and
Can cause disease in humans
Includes but not limited to:
- Hepatitis B virus (HBV)
- Hepatitis C virus (HCV)
- Human immunodeficiency virus (HIV)
1910.1030(b)
Hepatitis B virus
Malaria
Syphilis
Babesiosis
Brucellosis
Leptospirosis
Arboviral infections
Relapsing fever
Creutzfeld-Jakob Disease
Human T-Lymphotrophic Virus Type 1 and 2
Viral hemorrhagic fevers
Other Bloodborne PathogensCHAPTER 19 – HEALTH: EPIDEMIOLOGY SUBCHAPTER 19A – COMMUNICABLE DISEASE CONTROLSECTION .0100 - REPORTING OF COMMUNICABLE DISEASES15A NCAC 19A .0101 REPORTABLE DISEASES AND CONDITIONSLists over 60 different diseases – These are a few of them:
- Semen- Vaginal secretions- Cerebrospinal fluid- Synovial fluid- Pleural fluid- Pericardial fluid- Peritoneal fluid- Amniotic fluid- Saliva in dental procedures
- Any body fluid visibly contaminated with blood
- All body fluids in situations where it is difficult or impossible to differentiate between body fluids
Other Potentially Infectious Materials (OPIM)
OPIM 1910.1030(b)(1)
Contaminated
The presence or the reasonably anticipated presence of blood or OPIM on an item or surface
1910.1030(b)
Occupational Exposure
Reasonably anticipated contact with blood or OPIM
May result from the performance of an employee’s duties
Occurs by skin, eye, mucous membrane, or parenteral contact
1910.1030(b)
Exposure IncidentA specific contact with:
- Blood or OPIM- Results from the performance of an employee’s duties- Contact with:
» Eye, mouth, or other mucous membrane » Non-intact skin» Parenteral contact
1910.1030(b)
Exposure Control Plan (ECP) 1910.1030(c)
Exposure Control Plan
Written plan designed to eliminate or minimize employee exposure that contains:
- Exposure determination
- Schedule and method of implementing paragraphs (d)
through (h) of the standard
- Procedures for evaluating circumstances surrounding
an exposure incident
1910.1030(c)(1)(ii)
(cont...)
Exposure Control Plan
Accessible to employees
- Electronically
- Managers
- Human Resources
Reviewed and updated annually or more often if changes occur
Available to OSHA and NIOSH representatives
Employer is required to identify job classifications where occupational exposure can occur:
- Job classification in which ALL have occupational exposure
- Job classification in which SOME have occupational exposure
- List of all tasks and procedures in which occupational exposure occurs
Must be made without regard to the use of PPE
Exposure Determination 1910.1030(c)(2)
Category I Employees
Refers to PCC Licensed Medical Staff , Mobile Crisis and Crisis support staff that may have routine exposure to potentially infectious materials. Tasks/Procedures Include:
Taking of vital signs, e.g., blood pressure, pulse, temperature
Administration of oral and injectable medicationsBlood DrawsPerforming as appropriate CPR and basic first
aid
Category I (cont)
Category I employees shall receive training upon employment and annually thereafter in Exposure and infection control. In addition, this category of employee shall be offered Hepatitis B Vaccine, TB Testing, and Tetanus as appropriate….
Category I employees are offered Hepatitis B series vaccinations free of charge.
Category II EmployeeRefers to employees that receive First Aid training and are
expected to perform first aid duties as a collateral part of their position and may have occasional exposure to potentially infectious materials. Tasks/Procedures include:
Performing residential duties that include janitorial, laundry, cooking, washing clothes, etc.
Performs basic first aid and CPR as appropriate Utilizes restrictive interventions to manage consumer behavior Category II employees shall receive training upon employment and
annually thereafter in Exposure and infection control. This includes all PCC direct care clinical employees.
Category III Employees
Refers to employees that are not required to receive First Aid training and not expected to perform basic first aid duties. Employees in this category may have consumer contact in office or community setting and minimal exposure to potentially infectious diseases. This includes all PCC administrative and support employees.
Methods of Compliance
General - universal precautions
Engineering and work practice controls
Personal protective equipment
Housekeeping
1910.1030(d)
An approach to infection control
Originated by CDC
Concept:- All human blood and certain human body fluids are
to be treated as if known to be infectious for HIV, HBV, or other bloodborne pathogens
Universal Precautions 1910.1030(d)(1)
Examples of Engineering Controls
Needleless systems, e.g., IV connectors
Sharps with sharps injury protection
Puncture-resistant sharps containers
Mechanical needle recapping devices
Biosafety cabinets
Mechanical pipetting devices
Work Practice Controls
Altering behaviors
Function- Protection is based on
employer and employee behavior
- Protection not dependent on installation of a physical device such as protective shield
(cont...)
1910.1030(d)(2)
Work Practice ControlsWashing hands
- Employers shall provide readily accessible hand-washing facilities
- When not feasible, appropriate antiseptic hand cleansers shall be provided
- When gloves are removed
- ASAP after contact with body
fluids
1910.1030(d)(2)
(cont...)
Do Not Bend or Break
Contaminated Needles
Work Practice Controls 1910.1030(d)(2)(vii)
(cont...)
Work Practice Controls
Place contaminated reusable sharps in appropriate container until processing, containers should be:- Puncture-resistant
- Labeled or color-coded
- Leak proof on sides and bottom
- Stored or processed in a safe manner
1910.1030(d)(2)
(cont...)
Using mechanical devices or one-handed techniques to
recap or remove contaminated needles when necessary
Prohibiting eating, drinking, smoking, etc.
Food and drink must not be kept in the same storage as
potentially infectious material
Performing all procedures involving blood or OPIM so as
to minimize splashing, spattering, and droplet generation
Prohibiting mouth pipetting or suctioning of blood or
OPIM
Work Practice Controls 1910.1030(d)(2)
(cont...)
Personal Protective Equipment
Specialized clothing or equipment that is worn by an employee for protection against a hazard
- General work clothes (uniforms, pants, shirts and blouses) not intended to function as protection against a hazard are not considered personal protective equipment (PPE)
1910.1030(d)(3)
Examples of Types of PPEGlovesGownsFace shieldsEye protectionMouthpieces and resuscitation
devices
PPE - Gloves
Disposable (single use) gloves must be replaced when contaminated, torn or punctured
Disposable (single use) gloves shall not be washed or decontaminated for reuse
Utility gloves may be cleaned and re-used as long as they continue to provide a barrier for employee
1910.1030(d)(3)(ix)
Housekeeping - General
Employer shall develop and implement a written schedule for cleaning and decontamination at the worksite
Schedule is based on the:- Location within the facility- Type of surface to be cleaned- Type of soil present- Tasks or procedures being performed
1910.1030(d)(4)(i)
Contaminated work surfaces shall be
decontaminated:- After completion of procedures
- After contact with blood or OPIM and
- At end of work shift
Housekeeping Requirements 1910.1030(d)(4)(ii)[A]
(cont...)
Household bleach (5% NaOCl2)- 1:10 - 1:100 in H2O
EPA registered disinfectants- List A: EPA’s registered antimicrobial products as sterilants- List B: EPA registered tuberculocidal products effective against
Mycobacterium spp- List C: EPA’s registered antimicrobial products effective against human
HIV-1 Virus- List D: EPA’s registered antimicrobial products effective against human
HIV-1 and Hepatitis B virus- List E: EPA’s registered antimicrobial products effective against
Mycobacterium spp, human HIV-1 and Hepatitis B virus- List F: EPA’s registered antimicrobial products against Hepatitis C virus- List G: EPA’s registered antimicrobial products for medical waste
treatment
Appropriate Disinfectants
Hepatitis B Vaccination
The Hepatitis B vaccination and post-exposure evaluation and follow-up including prophylaxis shall be:
- Available to Category I employees at a reasonable time and place and without cost
- Performed by or under the supervision of a licensed physician or healthcare professional
- Provided according to current recommendations of the U.S. Public Health Service
1910.1030(f)
No out of pocket expense
Employer may not require employee to use his/her health care insurance to pay for series unless: - Employer pays all of the cost of health insurance,
and
- No cost to employee in form of deductibles, co-payments, or other expenses
No Cost to the Employee
Hepatitis B vaccination shall be made available: - After employee has received required training, and
- Within 10 days of initial assignment to all employees
with occupational exposure
Hepatitis B Vaccination 1910.1030(f)(2)(i)
(cont...)
Exceptions
- If the employee has previously completed the complete Hepatitis B vaccination series, or
- Immunity is confirmed through antibody testing, or
- The vaccine is contraindicated for medical reasons
Hepatitis B Vaccination 1910.1030(f)(2)(i)
(cont...)
Participation in prescreening not prerequisite for receiving Hepatitis B vaccination
Hepatitis B vaccination provided even if employee declines but later accepts treatment
Employee must sign statement when declining Hepatitis B vaccination
Hepatitis B vaccination booster doses must be available to employees if recommended by the USPHS
Hepatitis B Vaccination 1910.1030(f)(2)
Post-Exposure and Follow-Up
Documentation of exposure routes and how exposure incident occurred
Identification and documentation of source individual’s infectivity, if possible
Collection and testing of employee’s blood for HBV and HIV serological status (employee’s consent required)
Post exposure prophylaxis when medically indicated Counseling Evaluation of reported illnesses
1910.1030(f)(3)
PCC Post-Exposure Evaluation and Follow-up
When the employee incurs an exposure incident and upon appropriate clean-up and wash-up, the incident shall be reported. Reporting should be completed using the following procedures:
The employee should immediately notify the responsible supervisor and provide an accurate account of exposure. The supervisor will contact the Operations Officer during normal business hours or the on call manager during weekends and then provide the employee with instructions to follow that may include:
- Obtain consent and make arrangements to have the source individual tested as soon as possible to determine HIV, HCV, and HBV infectivity; document that the source individual’s test results were conveyed to the employee’s health care provider.
- If the source individual is already known to be HIV, HCV, and/or HBV positive, new testing need not be performed.
- Assure that the exposed employee is provided with the source individual’s test results and with information about applicable disclosure laws and regulations concerning the identity and infectious status of the source individual (e.g. laws protecting confidentiality, HIPAA, etc.)
- After obtaining consent, collect exposed employee’s blood as soon as feasible after exposure incident, and test blood for HBV and HIV serological status
- If the employee does not give consent for HIV serological testing during collection of blood for baseline testing, preserve the baseline sample for at least 90 days; if the exposed employee elects to have the baseline sample tested during this waiting period, perform testing as soon as feasible.
. As soon as possible and within
24 hours an adverse event form shall be completed and submitted to PCC’s Operations Officer. The adverse event form shall minimally include: documenting the routes of exposure and how the exposure occurred; and identifying and documenting the source individual (unless the employer can establish that identification is infeasible or prohibited by state or local law).
The adverse event form shall be reviewed within a quality management process and corrective action taken as appropriate.
PCC’s Quality and Performance Improvement Committee shall review adverse event forms and make recommendations as appropriate to improve PCC’s exposure control process.
The appropriate notification forms for OSHA requirements must be filled out and filed by the Human Resource Department, including Form 19. Human resources will ensure that the health care professional receives a copy of CFR 1910.10 (f) as well as the following information:
- A description of the employee’s job duties relevant to the exposure incident
- Route(s) of exposure- Circumstances of
exposure- If possible, results of the
source individual’s blood test
- Relevant employee medical records, including vaccination status
The health care provider shall provide the employee with a copy of its written opinion within 15 days after completion of the evaluation.
A copy should be forwarded and filed with Human Resources.
Recordkeeping
Medical records
Training records
Sharps injury log
1910.1030(h)
Availability of Records
Training records shall be provided upon request for examination and copying to:- Employees- Employee representatives- Director of NIOSH- OSHA
Availability of Records
Medical records shall be provided upon request for examination and copying to:- Employee- Anyone with written consent of employee- NIOSH- OSHA
(cont...)
Thank You For Attending!
Final Questions?